The patient was an 82-year-old male who was admitted to the hospital with “difficulty in eating and found to have a fundic cardia occupancy for 1 month”. The patient was admitted to the Department of Internal Medicine because he had many basic internal diseases such as chronic obstructive pulmonary disease, coronary heart disease, hypertension, and lacunar cerebral infarction, and was worried that he could not be operated. After admission, the patient’s difficulty in eating worsened, and the pathology confirmed that the patient had adenocarcinoma of the cardia of the fundus, and the patient increasingly requested surgery as soon as possible in the hope. After discussion with respiratory department, cardiology department, anesthesiology department, ICU and other departments, preoperative preparation was improved, and on 2011-2-24, under general anesthesia, a dissection, proximal gastrectomy, esophageal jejunostomy, stump gastrojejunostomy, jejunojejunostomy, and jejunostomy for cardia carcinoma of the fundus were performed. A little yellowish ascites was seen on admission, and there was no obvious metastasis in the pelvis. A 9*10 cm dark red mass with uneven surface and hard texture, involving the proximal side of the gastric body and surrounded by obvious enlarged lymph nodes with fusion, was found in the anterior wall of the gastric cardia and fundus. Further investigation of the cancer and lymph nodes could still be pushed, so it was decided to perform proximal gastrectomy, esophageal jejunostomy, stump gastrojejunostomy, jejunojejunostomy and jejunostomy for cardia in the fundus. The patient’s vital signs were stable and he was bleeding about 100ml, but the hemoglobin was only 78g/L before anesthesia. 4 units of blood pressure were transfused to correct anemia and blood loss, and 400ml of plasma was transfused to replenish coagulation factors. The patient was discharged as scheduled after a smooth recovery. In this case, the patient was 82 years old, with many combined underlying diseases and poor cardiopulmonary reserve, as well as poor nutrition, anemia and hypoproteinemia due to tumor progression. Many factors mentioned above affected the perioperative management, which needed to be fully considered and carefully handled in all aspects to make the patient recover safely.